心肌肌钙蛋白检测对心肌损伤的回顾性分析

Diagnosing acute myocardial infarction with troponins

目的：探讨新一代心肌肌钙蛋白T（cTnT）、肌钙蛋白I（cTnI）及肌酸激酶同工酶MB（cK-MB）早期诊断急性心肌梗死的临床应用价值.对23例急性心肌梗塞（AMI）患者、18例不稳定性心绞痛（UA）患者及23例非AMI患者的血清心肌钙蛋白I、肌钙蛋白T及CK-MB进行检测,分别进行组间比较,并对AMI组和UA组各指标做对比分析.结果：cTnT、cTnI诊断急性心肌梗死灵敏度一致（P〉0.05）,而均高于CK-MB（P〈0.01）.通过利用肌钙蛋白T正常值的临界值作为诊断标准,预防11例MACE的发生.肌钙蛋白T升高至临界值时,可以提示心肌损伤（调整后的OR值：4.6,P=0.039）,在随访的6个月内,主要心脏不良事件（MACE）（调整后的OR值：11.10,P＜0.0001）.结论：心肌肌钙蛋白I和肌钙蛋白T在AMI的早期诊断中具有较高灵敏度和较强特异性,采用肌钙蛋白T临界值,可以降低＂假阴性＂的发生.

Objective.. To observe tile application value of cardiactroponin I （cTnI）, cardiac tmponin T（cTnT） and creatine kinase MB（CK-MB） for the early diagnosis of acute myocardial infamfion（AMI）. Methods：To determin the plasma level Of cTnT.cTnI and CK-NB in patients （23 with acute myocardial infarction, 18 patients with unstable angina and 23 patients with other diseases）. Comparison between AMI and UA was performed and all the indexes Were analysed contrastively. Results：The sensitivity of cTnI and cTnT in diagnosing AMI are higher than that of CK-MB. Troponin T elevation below the functional sensitivity predicted the risk of death and AMI （adjusted OR 4.6 ,p=0. 039） and MACE （adjusted OR 11.10, p〈0. 0001） independently. Utilising the 99th percentile cut-off,an extra 17 MACEs could be predicted per 1000 patients treated at a cost of identifying 11 patients who would not have developed an event.